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Background <p>Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, with about 15 million preterm births occurring each year. Accurate prediction of preterm birth is essential for the implementation of effective interventions.</p> Aim <p>This study evaluates the combined predictive value of uterine electromyography (EMG) and transvaginal ultrasound (TVUS) cervical parameters for preterm birth in high-risk singleton pregnancies, assessing its superiority over individual methods.</p> Methods <p>A retrospective, propensity score-matched cohort study was conducted to collect data of pregnant women at high risk of preterm birth who gave birth in our hospital (Jan 2024–Apr 2025). After 1:1 matching, 180 participants were assigned to spontaneous preterm birth (sPTB, &lt; 37&#xa0;weeks, n = 90) or term birth (≥ 37&#xa0;weeks, n = 90) groups. At 20–24&#xa0;weeks, all underwent TVUS [cervical length (CL) and elastic strain rate (ESR)] and EMG [peak frequency (PK) and propagation velocity (PV)]. The primary aim was to compare the AUC of a combined model (CL + ESR + EMG–PV) versus CL alone. Secondary outcomes included group differences and each model’s sensitivity, specificity, and NPV. Logistic regression was used for multivariable analysis, and the DeLong test compared AUCs.</p> Results <p>After PSM, the baseline data of the two groups were balanced (<i>P</i> &gt; 0.05). The sPTB group had shorter CL and higher ESR, EMG–PK, and EMG–PV (all <i>P</i> &lt; 0.001). Multivariate logistic regression identified CL (OR = 0.85), ESR (OR = 1.32), and EMG–PV (OR = 1.45) as independent predictors. The combined model (CL + ESR + EMG–PV) yielded a significantly higher AUC (0.93, 95%CI 0.89–0.97) than CL alone (0.85, 95%CI 0.79–0.91; DeLong test, <i>P</i> = 0.002). The combined model also demonstrated superior sensitivity (88.9%), specificity (91.1%), and NPV (94.4%) compared with individual models.</p> Conclusions <p>Integrating TVUS cervical assessment with EMG monitoring significantly enhances preterm birth prediction in high-risk singletons, offering improved risk stratification despite limitations from its single-center retrospective design requiring future validation.</p>

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Predictive value of uterine electromyography coupled with transvaginal ultrasound cervical assessment in women at risk of preterm delivery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月2日

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  • Lin Zhang,
  • Yahong Mao,
  • Yan Shen,
  • Huiping Guo,
  • Songyuan Xu,
  • Lidan Shen,
  • Lili Chen,
  • Lihuan Lu,
  • Lingjue Yu

摘要

Background

Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, with about 15 million preterm births occurring each year. Accurate prediction of preterm birth is essential for the implementation of effective interventions.

Aim

This study evaluates the combined predictive value of uterine electromyography (EMG) and transvaginal ultrasound (TVUS) cervical parameters for preterm birth in high-risk singleton pregnancies, assessing its superiority over individual methods.

Methods

A retrospective, propensity score-matched cohort study was conducted to collect data of pregnant women at high risk of preterm birth who gave birth in our hospital (Jan 2024–Apr 2025). After 1:1 matching, 180 participants were assigned to spontaneous preterm birth (sPTB, < 37 weeks, n = 90) or term birth (≥ 37 weeks, n = 90) groups. At 20–24 weeks, all underwent TVUS [cervical length (CL) and elastic strain rate (ESR)] and EMG [peak frequency (PK) and propagation velocity (PV)]. The primary aim was to compare the AUC of a combined model (CL + ESR + EMG–PV) versus CL alone. Secondary outcomes included group differences and each model’s sensitivity, specificity, and NPV. Logistic regression was used for multivariable analysis, and the DeLong test compared AUCs.

Results

After PSM, the baseline data of the two groups were balanced (P > 0.05). The sPTB group had shorter CL and higher ESR, EMG–PK, and EMG–PV (all P < 0.001). Multivariate logistic regression identified CL (OR = 0.85), ESR (OR = 1.32), and EMG–PV (OR = 1.45) as independent predictors. The combined model (CL + ESR + EMG–PV) yielded a significantly higher AUC (0.93, 95%CI 0.89–0.97) than CL alone (0.85, 95%CI 0.79–0.91; DeLong test, P = 0.002). The combined model also demonstrated superior sensitivity (88.9%), specificity (91.1%), and NPV (94.4%) compared with individual models.

Conclusions

Integrating TVUS cervical assessment with EMG monitoring significantly enhances preterm birth prediction in high-risk singletons, offering improved risk stratification despite limitations from its single-center retrospective design requiring future validation.